Anxiolytic effect of aromatherapy massage in patients with breast cancer.

We examined how aromatherapy massage influenced psychologic and immunologic parameters in 12 breast cancer patients in an open semi-comparative trial. We compared the results 1 month before aromatherapy massage as a waiting control period with those during aromatherapy massage treatment and 1 month after the completion of aromatherapy sessions. The patients received a 30 min aromatherapy massage twice a week for 4 weeks (eight times in total). The results showed that anxiety was reduced in one 30 min aromatherapy massage in State-Trait Anxiety Inventory (STAI) test and also reduced in eight sequential aromatherapy massage sessions in the Hospital Anxiety and Depression Scale (HADS) test. Our results further suggested that aromatherapy massage ameliorated the immunologic state. Further investigations are required to confirm the anxiolytic effect of aromatherapy in breast cancer patients.

Induction of mitochondria-dependent apoptosis through the inhibition of mevalonate pathway in human breast cancer cells by YM529, a new third generation bisphosphonate.

YM529, a new third generation bisphosphonate, induced apoptosis of a human breast cancer cell line, MX-1. Cytotoxic activity of YM529 was more potent than that of incadronate. YM529 activated caspase-9, but not caspase-8, and induced the release of cytochrome c into cytosol. YM529 increased Bax expression and decreased Bcl-2 expression, while it did not induce caspase-8-dependent Bid truncation. Farnesyl pyrophosphate prevented YM529-mediated cytotoxicity. These results suggest that YM529 is a potent therapeutic agent for human breast cancers, activating the mitochondria-dependent apoptotic pathway through the inhibition of protein farnesylation.

[A case of multi-drug resistant recurrent breast cancer with multiple bone metastasis responding to TS-1 and trastuzumab].

We experienced a case of multi-drug resistant recurrent breast cancer with multiple bone metastases achieving a significant improvement by TS-1 and trastuzumab. The prior treatments including taxane or vinorelbine and trastuzumab were changed in the regimen to TS-1 and trastuzumab because of the progressive disease. TS-1 was administered orally at 100 mg/day everyday for 2 weeks, followed by a 1-week rest interval as 1 cycle, and trastuzumab was injected at 2 mg/kg/week for 4 weeks, followed by a 1-week rest interval as 1 cycle. After 3 cycles of the treatment, the level of tumor markers and tumor sizes of bone metastases became reduced. In conclusion, the combination treatment of TS-1 and trastuzumab is thought to be effective for multi-drug resistant recurrent breast cancer.

Establishment of seminars to improve the diagnostic accuracy and effectiveness of breast ultrasound.

PURPOSE: To improve the ability of technicians and physicians to find and diagnose breast lesions in breast ultrasound screening. METHODS: Seminars were organized for technicians and physicians engaged in breast ultrasound screening, and tests were carried out to evaluate the usefulness of the seminars. Each seminar lasted 2 days and comprised lectures and group activities. Pretests and post-tests conducted before and after each seminar, respectively, consisted of 100 questions: 50 about animated images, and 50 about static images. The tests required the participant to find lesions in animated images and estimate the probability of malignancy from static images. RESULTS: In the animated image tests, sensitivity was greater after the seminar, although specificity did not change significantly. In the static image tests, sensitivity increased, and a significant increase was also observed in the receiver operating curve analysis for degree of certainty in diagnosing cancer. CONCLUSION: The seminars improved the participants' ability to find and diagnose breast lesions during ultrasound screening.

A case of non-metastatic giant mucinous carcinoma of the breast.

A surgically resected case of giant mucinous carcinoma of the breast that had remained untreated for 2 years is reported. A 64-year-old postmenopausal woman presented with a large right breast mass (17.4 x 16.5 x 14.5 cm). Although she had noticed a mass in the right breast 2 years previously, she had not sought treatment. Mucinous carcinoma was diagnosed by core needle biopsy and she underwent right modified radical mastectomy with a free skin graft. There were no lymph node metastases or distant metastases. Fourteen months postoperatively, she remains well without evidence of tumor recurrence. Although several reports have suggested that pure mucinous carcinoma of the breast has a favorable prognosis, we need to follow this case until the clinical behavior and the outcome become clear.

[Progress in endoscopic surgery for breast cancer].

Breast conserving surgery has become the commonest surgery for breast cancer in Japan. And the cosmetic results have become more and more important. The main characteristics of endoscopy assisted surgery for breast cancer can realize radical resection and immediate reconstruction from a small skin incision and inconspicuous scars. Because the endoscopy-assisted surgery assures not only higher curativity but also better cosmetic results, the indications will increase more and more.

[Key issues in sentinel node biopsy for breast cancer].

Whereas the majority of surgeons in Western countries perform sentinel node biopsy (SNB) for early breast cancer, the majority of Japanese surgeons do not. Veronesi very recently reported the results of a clinical trial in which SNB without axillary lymph node dissection for small breast cancer did not increase axillary recurrence. Thus, sentinel node surgery has been accepted as a safe and accurate method of screening the axillary nodes for metastasis in women with small breast cancer. SNB should thus be recommended as standard care for early breast cancer in Japan. SNB for patients with ductal carcinoma in situ (DCIS) may be performed according to the decision of doctors or patients in each case, because the indication of SNB for DCIS is controversial. Since preoperative chemotherapy could increase the rate of false-negative sentinel nodes because of the induced lymphatic changes, SNB is thought to be safer before than after preoperative chemotherapy. Current evidence does not allow internal mammary SNB to be recommended as a standard procedure, but as patients with internal mammary node involvement may benefit from adjuvant systemic treatment, internal mammary SNB should be further studied in this context. Preoperative diagnosis of an axillary metastasis using fine-needle aspiration cytology (FNAC) under ultrasonographical imaging or core needle biopsy under MR imaging can cost-effectively decrease the indications of SNB.

MR imaging-guided axillary node biopsy for breast cancer: initial findings.

The aim of this study was to evaluate the usefulness and feasibility of preoperative sentinel node needle biopsy of the breast under guidance of open MR imaging, a method that we developed. Nine patients with breast cancer in whom the axillary lymph nodes were not palpable underwent preoperative sentinel node needle biopsy under real-time MR imaging guidance. The sentinel nodes were identified before the biopsy using CT and MR imaging. Diagnostic ability of this method was compared with that of the operative diagnosis. Sentinel nodes were correctly identified in all 9 patients. The MR imaging-guided sentinel node needle biopsy was performed for all of the 9 patients, and, in 7 (77.8%) of the 9, a specimen sufficient for pathologic evaluation was obtained; and in 6, whether malignancy existed was precisely diagnosed. No serious complications were noted. This experience indicates the possibility of a precise diagnosis of whether the sentinel node in breast cancer is benign or malignant without surgery.

[Sentinel lymph node biopsy and low axillary node sampling for breast cancer].

Since sentinel lymph node(SLN) biopsy has a higher negative predictive value than that of four-node sampling, SLN biopsy might become the new acknowledged standard of clinical care for patients with early breast cancer. SLN biopsy is widely used in Western countries despite the lack of data from randomized trials. Clinical practice guidelines document that SLN biopsy should be performed with prudent informed consent and thorough surgical technique. Before surgeons replace axillary dissection with SLN biopsy as the staging procedure at their institution, they should perform backup axillary dissection until a detection rate of more than 90% and a false-negative rate of less than 5% are achieved. Recently, SLN biopsy has more often been indicated for multicentric breast cancer, larger tumors, prior excisions, and noninvasive carcinoma. While SLN biopsy is widely used in Western countries, there is little experience in Japan. If randomized studies, clinical practice guidelines, and the coverage of lymphoscintigraphy under health insurance were introduced, SLN biopsy would be used more widely in Japan.

Results of combined complete removal of directly invaded organs with the stomach in patients with advanced gastric cancer.

BACKGROUND/AIMS: The prognosis of some patients with gastric tumors that have infiltrated adjacent organs may be improved by operations that include complete removal of these structures. However, such a radical operation raises concerns about operative risk. METHODOLOGY: We performed a retrospective analysis of 55 patients whose gastric primary tumors invaded adjacent organs to evaluate the effect of combined removal on postoperative survival. Prognostic factors were also determined by the univariate and multivariate analysis. RESULTS: Cumulative 5-year survival of patients who underwent complete removal of invaded organs was significantly higher than that of patients who did not undergo complete removal of invaded organs or gastrectomy alone. No significant difference was noted between groups in mortality at 30 days after operation. Univariate and multivariate analysis seeking prognostic factors revealed that completeness of the combined removal of invaded organs was among the predictors of outcome. CONCLUSIONS: In conclusion, our study suggested that complete removal of invaded organs simultaneously with gastrectomy can prolong postoperative survival of patients with gastric cancer directly invading adjacent organs.